OUTCOME OF CAPSULAR INVASION IN CLINICALLY LOCALIZED RENAL TUMOR

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some of them can grow rapidly. More attention should be given to the observation of incidentally discovered renal masses. Source of Funding: None

966 DOES TUMOR SIZE HAVE SIGNIFICANCE IN pT2 RENAL CELL CARCINOMA? A SINGLE CENTER EXPERIENCE Narmada P Gupta*, Anup Kumar, Ashok K Hemal, Prem N Dogra, Amlesh Seth, Rajeev Kumar. Delhi, India. INTRODUCTION AND OBJECTIVE: According to the current 710FODVVL¿FDWLRQ S7UHQDOWXPRUVDUHWKRVHODUJHUWKDQFP LQWKHODUJHVWGLPHQVLRQDQGFRQ¿QHGWRWKHNLGQH\:HKDYHDQDO\]HG RXU VLQJOH FHQWHU H[SHULHQFH WR ¿QG RXW ZKHWKHU WXPRU VL]H KDV DQ\ VLJQL¿FDQFHZLWKLQS710UHQDOFHOOFDUFLQRPD5&& DQGZKHWKHU S7UHTXLUHVIXUWKHUVXEFODVVL¿FDWLRQIRUEHWWHUSURJQRVWLFDWLRQRIUHQDO tumors after surgery. METHODS: The study included 149 patients of pT2 RCC, who underwent radical nephrectomy (open and laparoscopic), from May WR-XO\7KHSDWLHQWVZHUHFODVVL¿HGLQWRJURXSVS7D SDWLHQWVWXPRUVL]HFP DQGS7ESDWLHQWVWXPRUVL]HPRUH than or equal to 10cm). Clinical data of 2 groups including operative, postoperative management, pathological results and follow- up were UHFRUGHGDQGDQDO\]HGVWDWLVWLFDOO\LQFOXGLQJ\HDUGLVHDVHIUHHVXUYLYDO \HDUFDQFHUVSHFL¿FVXUYLYDODQG\HDURYHUDOOVXUYLYDO RESULTS: 94 patients and 55 patients underwent open and ODSDURVFRSLFUDGLFDOQHSKUHFWRP\UHVSHFWLYHO\7KHPHDQWXPRUVL]HZDV 8.5 cm and 12.3 cm in pT2a and p T2b respectively (p = 0.02). The mean operating time, estimated blood loss, blood transfusion requirement, analgesic requirement, hospital stay, time taken for recovery, LQWUDRSHUDWLYHDQGSRVWRSHUDWLYHFRPSOLFDWLRQVZHUHVLJQL¿FDQWO\KLJKHU LQS7EJURXS7KH)XKUPDQJUDGHZDVVLJQL¿FDQWO\KLJKHULQS7E group. The mean follow up was comparable in 2 groups (55.4 and 57.2 months in pT2a and pT2b respectively). The distant metastases were VLJQL¿FDQWO\KLJKHULQS7EJURXSS  7KH\HDUGLVHDVHIUHH VXUYLYDO\HDUFDQFHUVSHFL¿FVXUYLYDODQG\HDURYHUDOOVXUYLYDOZHUH VLJQL¿FDQWO\OHVVHULQS7EJURXSSDQGUHVSHFWLYHO\  ,Q0XOWLYDULDWH&R[UHJUHVVLRQDQDO\VLVWXPRUVL]HZDVIRXQGWREHDQ LQGHSHQGHQWDQGVWURQJSURJQRVWLFIDFWRUIRUFDQFHUVSHFL¿FVXUYLYDO in pT2N0M0 RCC. CONCLUSIONS: The patients in pT2bN0M0 RCC had more estimated blood loss, intra and postoperative complications, higher tumor JUDGHGLVWDQWPHWDVWDVHVZLWKOHVVHU\HDUFDQFHUVSHFL¿FVXUYLYDO thus resulting in poorer prognosis than pT2aN0M0 RCC. Therefore, the FXUUHQWS7FODVVL¿FDWLRQFDQEHIXUWKHULPSURYHGE\VXEFODVVLI\LQJLQWR S7DDQGS7EZLWKWXPRUVL]HFXWRIIRIFP Source of Funding: None

967 INVASION OF RENAL SINUS FAT NEGATIVELY IMPACTS SURVIVAL IN pT3a RENAL CELL CARCINOMA Stephen A Poon*, Joshua R Gonzalez, Alana M Murphy, Carl A Olsson, Mitchell C Benson, James M McKiernan. New York, NY. INTRODUCTION AND OBJECTIVE: Under the current TNM FODVVL¿FDWLRQ SDWLHQWV ZLWK LQYDVLRQ RI SHULUHQDO IDW 3)  RU VLQXV IDW (SF) without tumor thrombus are consolidated within the T3a grouping. Tumors with SF invasion are in closer proximity to the renal veins, lymphatics, and collecting system. Others have proposed that this FDUULHVDZRUVHSURJQRVLVIRUGLVHDVHVSHFL¿FVXUYLYDO'66 EXWWKH present literature is limited and contradictory. We sought to clarify the SURJQRVWLFVLJQL¿FDQFHRIWKHORFDWLRQRIH[WUDUHQDOWXPRUH[WHQVLRQRQ cancer DSS after nephrectomy. METHODS: The institutional review board-approved Columbia University Comprehensive Urologic Oncology Database of 1244 patients treated with partial or radical nephrectomy from 1988 to present was reviewed for patients with pT3a renal tumors. Pathology reports were UHYLHZHG DQG UHQDO WXPRUV ZHUH FODVVL¿HG DV KDYLQJ 6) RU 3)RQO\ invasion. Patients with nonrenal histology, ipsilateral adrenal invasion, and bilateral tumors were excluded from analyses. The Kaplan Meier log-rank test was used to compare DSS between SF and PF invasion. The prognostic importance of clinical and pathological variables were

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also investigated using univariate and multivariate Cox proportional KD]DUGVUHJUHVVLRQV RESULTS: The 230 patients who met the inclusion criteria KDGDPHGLDQIROORZXSRIPRQWKVLQWHUTXDUWLOHUDQJH>,45@  SF invasion was found in 63 (27.4%) patients and was associated with a worse 5-year DSS survival when compared to the 167 (72.6%) patients ZLWK3)RQO\LQYDVLRQYV\HDU'66UHVSHFWLYHO\ORJ UDQN S   2Q XQLYDULDWH DQDO\VLV WXPRU GLDPHWHU KD]DUG UDWLR >+5@  S   KLJK QXFOHDU JUDGH +5  S  PDUJLQ status (HR 5.8, p=0.004), lymph node metastases (HR 6.4, p=0.001), DQG V\VWHPLF PHWDVWDVHV +5  S  ZHUH DOVR VLJQL¿FDQW for DSS. After placing these predictors into a multivariate model, only nuclear grade (HR 3.1, p=0.003), margin status (HR 8.9, p=0.001), and V\VWHPLFPHWDVWDVHV+5S UHPDLQHGVLJQL¿FDQWSUHGLFWRUV In multivariate analysis, the sinus fat invasion carried a HR 1.6 (95% CI 0.796-3.111, p=0.192). CONCLUSIONS: Patients with renal tumors that invade into SF are more likely to die from RCC than those with PF-only invasion. However in our surgical cohort, the presence of SF invasion is not an independent predictor for DSS. Source of Funding: None

968 MANAGEMENT OF IPSILATERAL ADRENAL GLAND DURING PARTIAL NEPHRECTOMY Brian R Lane*, Christopher J Weight, Ho Yee Tiong, Benjamin T Larson, Edward Diaz, Andrew C Novick, Inderbir S Gill, Stuart M Flechner. Cleveland, OH. INTRODUCTION AND OBJECTIVE: Robson’s radical nephrectomy has been replaced over the years with minimallyinvasive techniques and partial nephrectomy (PNx). The indications for adrenalectomy (Ax) for patients undergoing PNx are not clearly GH¿QHG:HDQDO\]HGLQLWLDOPDQDJHPHQWDQGRQFRORJLFRXWFRPHVRIWKH ipsilateral adrenal gland after open PNx in a single surgeon series. METHODS: Information regarding all PNx’s performed at a single institution was collected in an IRB-approved registry. Data regarding all 805 patients that underwent open PNx by a single surgeon (ACN) between 1999 and 2005 are included. The ipsilateral adrenal gland is routinely resected if a suspicious adrenal nodule is noted on UDGLRJUDSKLFLPDJLQJRULQWUDRSHUDWLYH¿QGLQJVLQGLFDWHGLUHFWH[WHQVLRQ or metastasis. RESULTS: Of 805 open PNx, concomitant Ax was performed in 23 patients (2.8%). Pathologic analysis revealed direct invasion of periadrenal fat by RCC (1), RCC metastasis (1), or benign tissue (21, 91%). During a mean follow-up of 2.0 years, ipsilateral adrenal PHWDVWDVLV ZDV LGHQWL¿HG LQ  SDWLHQWV   2YHUDOO VXUYLYDO DW  years in patients undergoing open PNx with or without Ax was 74% and 85% (p=0.08). CONCLUSIONS: Over 90% of suspicious adrenal nodules resected at the time of open PNx for presumed renal cell carcinoma are benign. Overall survival comparing patients undergoing PNx with LSVLODWHUDO DGUHQDOHFWRP\ ZHUH VLPLODU WR 31[ DORQH 7KHVH ¿QGLQJV support the practice of resecting the ipsilateral adrenal gland only in the presence of a suspicious lesion. Adrenalectomy should not routinely be performed is not mandatory during PNx for the upper pole tumors. Source of Funding: None

969 OUTCOME OF CAPSULAR INVASION IN CLINICALLY LOCALIZED RENAL TUMOR Darwin L Lim*, Mazen Abdelhady, Stephen E Pautler, Jonathan I Izawa, Joseph L Chin. London, ON, Canada. INTRODUCTION AND OBJECTIVE: We assessed the outcome and clinical behaviour of pathologic T1-T2 RCC with capsular invasion compare to those with pathologic T1-T2 disease without invasion. METHODS: All patients (pts) with clinical T1-2 diseases who underwent radical (RN) or partial(PN) nephrectomy in our institution from 1994-2006 were included the study. All patients underwent preoperative CT or magnetic resonance imaging (MRI) for clinical staging. Post-

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RSHUDWLYHWXPRUVL]HSDWKRORJLFJUDGHWRJHWKHUZLWK\HDUUHFXUUHQFH free survival data were determined. RESULTS: A total of 269 pts with clinical T1 (n=213) or T2 (n=56) who underwent radical or partial nephrectomy were included in the study. Median age was 61 +/- 12 y/o and median follow up was 33.5 months. Partial nephrectomy was done in 77 pts. Ninety-four patients (RN=67, PN=27) underwent laparoscopic surgery. Final pathological staging showed that 34 (12.6%) pts have capsular invasion. Of the 34, 3 pts had PN and 31 pts underwent RN. 23 pts were cT1 and 11 were cT2 disease while 3 pts had PN and 31 pts underwent RN. Higher )XKUPDQJUDGHDQGODUJHUWXPRUVL]HYV ZHUH noted with the capsular invasion grp (p<0.0002, p<0.0001, respectively). Disease recurrence was found in 5.1% and 23.5% of pts without and with capsular invasion, respectively. The 5 year recurrence free survival rate was 92.24% and 73.58 % for pT1-2 without and with capsular invasion, respectively (p <0.0001). &21&/86,2167KRXJKSDWKRORJLFDOO\ORFDOL]HGWXPRU7  without capsular invasion were staged similarly to those with capsular invasion, our study showed that pT1-2 tumor with capsular invasion EHKDYHVPRUHDJJUHVVLYHO\DQGGLVHDVHUHFXUUHQFHZDVVLJQL¿FDQWO\ higher compared to those without capsular invasion. Meticulous clinical follow up protocol for this group of patients is warranted. Source of Funding: None

Sexual Function/Dysfunction/Andrology: Basic Research (III) Moderated Poster Session 34 Monday, May 19, 2008

1:00 - 3:00 pm

970 ULTRASTRUCTURAL CHANGES OF THE TUNICA ALBUGINEA IN RESPONSE TO CAVERNOSAL NERVE INJURY IN RATS Levent Gurkan*, Andrew Harbin, Philip J Dorsey, Wayne J G Hellstrom. New Orleans, LA. INTRODUCTION AND OBJECTIVE: Prostate cancer is the most common solid malignancy in men and radical prostatectomy is FRQVLGHUHGWKHHIIHFWLYHWUHDWPHQWIRUWKLVRUJDQFRQ¿QHGGLVHDVH:LWK advances in anatomical understanding and surgical techniques, major complications due to cavernosal nerve injury often experienced with prostatectomy such as erectile dysfunction (ED) and urinary incontinence are more often preventable. As a result, the previously secondary complications of penile shortening and Peyronie’s disease (PD) have become the primary complications of prostatectomy. Most researchers SRLQWWRFDYHUQRVDO¿EURVLVDVWKHHWLRORJ\ZKLOHRWKHUVFRQWHQGLWLV the tunica albuginea. This study was designed to explore the role that changes in the tunica albuginea have in causing penile shortening and ED observed after cavernous nerve injury. METHODS: The initial design consisted of one control (n=6) and one study arm to elucidate tunica albuginea changes in response to bilateral cavernosal nerve crush after four weeks (n=6) in rats. Four additional study arms were added to track the changes over time, namely two rats evaluated at the 1st, 2nd, 6th, and 10th weeks. At the predetermined time points, erectile responses were evaluated using cavernosal nerve stimulation (CNS) and tissue samples were collected for electron and light microscopy evaluation. Hematoxylin, eosin and Masson’s trichrome stains were used to correctly determine the changes under light microscope. RESULTS: Progressive degenerative changes were detected in the tunica albuginea despite ongoing recovery of erectile function at later time points in the study. Pictorial changes including collagen and elastin ratios, tunica albuginea thickness and irregularities, collagen VL]HV DQG WKHLU FRUUHODWLRQ ZLWK HUHFWLOH SUHVVXUHV VKRZHG FRQVLVWHQW ¿QGLQJV CONCLUSIONS: Despite recovery of erectile function in response to CNS, progressive histological changes were observed in the tunica albuginea. These tunical changes likely contribute to shortening and the new onset of PD post prostatectomy. Source of Funding: None

971 ASSESSMENT OF THE USE OF SILDENAFIL CITRATE FOR THE PROTECTION OF ERECTILE TISSUE AND FUNCTION FOLLOWING CASTRATION IN THE RAT MODEL Alexander Muller*, Serkan Deveci, Raanan Tal, Keith Kobylarz, John P Mulhall. New York, NY. INTRODUCTION AND OBJECTIVE: Castration is a wellestablished treatment strategy for metastatic prostate cancer. In animal models, testosterone deprivation to castration level has been shown to induce penile changes leading to venous leak. In animal and KXPDQPRGHOVVLOGHQD¿O9 KDVEHHQVKRZQWRLPSURYHSUHVHUYDWLRQ of smooth muscle in response to cavernous nerve (CN) injury and P\RFDUGLDO LQIDUFWLRQ 7KLV VWXG\ ZDV FRQGXFWHG WR GH¿QH LI 9 FRXOG reduce the functional and structural changes that occur in the rat penis after castration. METHODS: 50 Sprague-Dawley rats were studied, 40 underwent a bilateral orchiectomy (O). The animals were divided into 5 groups, with 10 animals/group undergoing erectile hemodynamics, 5 animals each assessed at two time points (7, 28 days). Sham animals (S) had no orchiectomy. Control animals had orchiectomy only (O7 and O28), and the treatment animals were injected with V 20 mg/kg sc daily after castration for 7 or 28 days (V7, V28). Functional analysis was assessed by measuring mean maximum ICP/MAP ratios after CN VWLPXODWLRQ 781(/ DVVD\ ZDV XVHG WR GH¿QH DSRSWRWLF LQGLFHV $,  and Masson’s trichrome (MT) staining was used to measure smooth muscle-collagen ratios. RESULTS: Both treatment groups (V7, V28) showed a significant improvement in ICP/MAP ratio compared to their FRUUHVSRQGLQJ FRQWURO JURXS 2 2  VHH 7DEOH  1R VLJQL¿FDQW differences existed in ICP/MAP at 28 days compared to 7 days for each groups, but the V groups had higher ratios that the control at both time points. However, even with V treatment, ICP/MAP values for V7 DQG 9 UHPDLQHG VLJQL¿FDQWO\ EHORZ WKH 6 JURXS S 7KH $,IRUWKH6JURXSZDV1RVLJQL¿FDQWGLIIHUHQFHVZHUHVHHQLQ $,EHWZHHQ2DQG9JURXSV2YV9S 2YV9S   6PRRWKPXVFOHFROODJHQUDWLRIRU9ZDVDQGVLJQL¿FDQWO\KLJKHU compared to 7% for O7 and V7 (p<0.05). CONCLUSIONS: Daily V treatment for 7 days as well as 28 days improved erectile function in rats after surgical castration. ICP/ 0$3UDWLRLQFUHDVHGVLJQL¿FDQWO\LQERWKWUHDWPHQWJURXSVFRPSDUHG to control with the greatest protection of erectile function occurring after 28 days of V administration which appears to be mediated by smooth muscle preservation. ICP/MAP Ratio in % 7 days Sham 70 Orhiectomy 36 6LOGHQD¿O 42 Pvalue < 0.05

28 days 69 37 49 < 0.005

P value NS 0.6 0.1

Source of Funding: None

972 EXPRESSION OF CAVEOLIN-1 IN CAVERNOUS TISSUE ON A DENERVATED ANIMAL MODEL. IMPACT OF SILDENAFIL Edgardo F Becher*, Jorge Toblli, Carlos Nolazco, Claudio Rosenfeld, Halina Grosman, Elba Vazquez, Cynthia Castronuovo, Osvaldo N Mazza. Buenos Aires, Argentina. INTRODUCTION AND OBJECTIVE: Radical pelvic surgery is DPDMRUFDXVHRIHUHFWLOHG\VIXQFWLRQLWLVUHODWHGWRWKHH[WHQWRIQHXUDO LQMXU\DQGPLJKWEHLQÀXHQFHGE\HDUO\SKDUPDFRORJLFDOLQWHUYHQWLRQ &DYHRODH DUH VSHFLDOL]HG SODVPD PHPEUDQH LQYDJLQDWLRQV RQ WKH surface of most cells involved in endocytosis. Animal studies showed that aging and hypertension affects trabecular smooth muscle/collagen ratio and as well as the concentration of caveolae and hence, a reduced expression of caveolin-1 (Cav-1). The objective is to determine de expression of Cav-1 as marker of cavernous tissue damage and to HYDOXDWHWKHLPSDFWRIHDUO\VLOGHQD¿ODGPLQLVWUDWLRQLQDQDQLPDOPRGHO of partial and total penile denervation. METHODS: 36 adult Sprague-Dawley rats were divided into 6 groups (n:6) of bilateral, unilateral penile denervation and sham